Long COVID Disparities Revealed in New Study From England

New research out of England, which incorporated data from the National Health Service (NHS), shows that although socially disadvantaged areas have the greatest need for resources to diagnose, treat, and support patients who have long COVID, the gap in provision of those resources continues to widen compared with more well-off communities. Further, there is a considerable degree of uncertainty among close to 10% of the population who think they could have long COVID but have yet to receive that diagnosis.¹

In connection with the 5-year anniversary of the COVID-19 pandemic, which just passed on March 11, more and more research is coming to light on the impact that long COVID has had and continues to have on the global population. Data backing the importance of the present analysis show that 3.3% of the population in the United Kingdom (2 million individuals) are thought to have long COVID, with 69% of adults and children experiencing it for at least 1 year and 41% experiencing it for at least 2 years.²

Findings published online today in Health Expectations demonstrate that both a lay population and those working on the health care front lines need to be made more aware of the prevalence of long COVID; in addition, health care professionals may require additional training that focuses on potential unconscious bias that could be hindering their ability to provide equitable care and support to all patients.¹

“We were really surprised to find so many people weren’t sure whether they had long COVID or not,” said study author Mirembe Woodrow, MSc, University of Southampton, in a statement. “The study shows there is still work to do to increase awareness of the condition and remove barriers to accessing diagnosis, treatment and support.”³

Long COVID Prevalence and Certainty

Outcomes were compared between individuals who did and did not have long COVID, as well as those who remained uncertain if they had long COVID. The NHS data were gathered through the annual General Practice Patient Survey on a randomized sample of patients 16 years and older (close to 2.5 million registrants each year); for the 2022 version, in addition to the usual questions about experience with their local general practice, other NHS services, and their overall health, patients were asked about long COVID.

The overall survey response rate was 28.6%, or 759,149 people.

Of this group, 4.8% (n = 35,445) said they had long COVID, with the highest prevalence being in the North West region of England and the lowest being in the South West region: 5.5% vs 3.9%. A 12% higher risk (unadjusted OR, 1.12; 95% CI, 1.06-1.19) of long COVID was also seen in persons who were unemployed and a 92% higher risk (unadjusted OR, 1.92; 95% CI, 1.84-2.00) was seen among those who were permanently sick or disabled

Most individuals reporting yes to having long COVID identified as female (59.9%)—which translates to a 12% lesser chance of those who identified as male claiming the same (adjusted OR [aOR], 0.88l; 95%CI, 0.86-0.90)—were aged 35 to 64 years (60.7%), and had a 47% greater risk (aOR, 1.47; 95% CI, 1.42-1.53) of living in the most deprived area quintile.

Higher prevalences of long COVID were also seen among respondents who identified as gay or lesbian, bisexual, or “other”; who were parents vs not a parent; and who were caregivers vs not a caregiver. In addition, higher chances of having long COVID were seen in survey respondents who reported a Buddhist, Christian, Muslim, Sikh, and “other” religion, and who reported the following backgrounds: White Gypsy or Irish Traveller, any other White, White and Asian and “other” mixed ethnicity, and “any other ethnic group.” Those who reported a Black or Chinese ethnicity were less likely to report long COVID.

When comorbidities were considered, higher rates of long COVID were seen in persons who had Alzheimer disease/dementia (9.2%), a breathing condition (9.0%), a mental health condition (9.2%), or a long-term condition not listed (7.8%). The overall risk of reporting long COVID in the setting of just 1 comorbidity was 97% (aOR, 1.97; 95% CI, 1.92-2.01).

The groups with the least likelihood of reporting uncertainty about having long COVID were persons aged 16 to 24 years; those identifying as female, gay/lesbian, and other; parents; White Gypsy or Irish Traveller groups vs persons reporting a White British ethnicity; and people who were permanently sick or disabled.

Study Strengths and Limitations

These findings are strong because they show a high burden of disease that is significantly likely to have an adverse impact on individuals and their families, the economy, and society at large, the study authors wrote. This was also a large, national sample, with results that echo previous research on how social determinants, such as deprivation, employment status, and comorbidities, can influence long COVID–related outcomes.^2,4-6

“Long COVID is unequally distributed in England, with the condition being more prevalent in minoritized and disadvantaged groups,” the authors wrote. “This study adds new evidence that there are more people who are unsure whether they have Long COVID than those who are confident they have it, again some from more vulnerable groups.”

This uncertainty, they caution, could indicate a lack of awareness, even confusion, about long COVID and its symptoms. As a result of their findings, future surveys will ask about the primary care support persons with long COVID received and investigating relationships with multilevel factors that could influence these knowledge outcomes.

“Improved awareness about the condition amongst the general population is required,” the study authors concluded, “and in addition, effort should be made to target campaigns towards groups in which LC is more prevalent.”

References

1. Woodrow M, Ziauddeen N, Smith D, Alwan NA. Exploring long Covid prevalence and patient uncertainty by sociodemographic characteristics using GP Patient Survey data. Health Expect. Published online March 17, 2025. doi:10.1111/hex.70202

2. Self-reported coronavirus (COVID-19) infections and associated symptoms, England and Scotland: November 2023 to March 2024. Office for National Statistics. April 25, 2024. Accessed March 17, 2025. https://www.ons.gov.uk/releases/findingsfromthewintercoronaviruscovid19infectionstudyselfreportedcovid19infectionsandassociatedsymptoms

3. Nearly one in ten unsure if they have long Covid. EurekAlert. March 17, 2025 Accessed March 17, 2025. https://www.eurekalert.org/news-releases/1076866?

4. Luo D, Mei B, Wang P, et al. Prevalence and risk factors for persistent symptoms after COVID-19: a systematic review and meta-analysis. Clin Microbiol Infect. 2024;30(3):328-335. doi:10.1016/j.cmi.2023.10.016

5. Subramanian A, Nirantharakumar K, Hughes S, et al. Symptoms and risk factors for long COVID in non-hospitalized adults. Nat Med. 2022;28(8):1706-1714. doi:10.1038/s41591-022-01909-w

6. Thompson EJ, Williams DM, Walker AJ, et al. Long COVID burden and risk factors in 10 UK longitudinal studies and electronic health records. Nat Commun. 2022;13(1):3528. doi:10.1038/s41467-022-30836-0